Provider Demographics
NPI:1366719809
Name:GOODMAN, PAMELA ELAINE (RN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ELAINE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 DONOVAN DR
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-9077
Mailing Address - Country:US
Mailing Address - Phone:607-427-2250
Mailing Address - Fax:
Practice Address - Street 1:DARTT CROSSROAD & ROUTE 34
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:NY
Practice Address - Zip Code:14883
Practice Address - Country:US
Practice Address - Phone:607-589-7148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY443645390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program